Peripheral Artery Disease: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing).
    • Skin and mucous membranes [ulcerations (skin ulcers) (stage IV according to Fontaine); accompanying symptoms as the disease progresses:
      • Paleness of the affected extremity
      • Clearly thickened nails
      • Shiny skin
      • Hair loss in the affected area
      • Decreased skin temperature
      • Localized peripheral cyanosis – bluish discolored skin due to lack of oxygen/at affected site]
      • Abdomen (abdomen):
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Extremities (palpation (palpation) of peripheral pulses) [palpable?, muscle atrophy?]
  • Auscultation (listening) of the heart and central arteries (flow sounds?).
  • Auscultation of the lungs
  • Palpation of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
• Positional test according to Ratschow (for patients in pAVK stage I and II) [helpful, but error-prone] Execution: patient lying on his back should raise the legs at an angle of 90 ° and make circular movements or ankle movements for a maximum of two minutes or until the onset of pain. At the end of this time, the patient sits down and lets the legs hang down. Interpretation:
  • Slight diffuse redness of the feet (normal: achieved within 5 seconds; in pAVD: 20 to 60 seconds).
  • Vein filling on the dorsum of the foot (normal: up to 20 seconds: in pAVD: > 60 seconds.

  During the Ratschow positioning test, other signs should be watched for:

  • Paling of the soles of the feet when held high.
  • Lateral difference of the coloration of the feet
  • If necessary, pain when lifting the leg
• Determination of the ankle-brachial index – first, the systolic blood pressure is measured at the ankle and upper arm; a quotient is then formed from these values; values for healthy individuals are ≥ 1 (measured from the systolic blood pressure at the ankle divided by the systolic blood pressure at the upper arm); if the quotient value is below 0.9, a damaged vascular system is present and if < 0.7, a higher-grade vascular change is likely.
• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.

Differentiation of peripheral arterial disease (pAVD) from neuropathy